Estimated Value Of Heart Rate And Blood Pressure In The Diagnosis And Prognosis Of Postural Tachycardia Syndrome In Children And Adolescents

Objective:To explore the value of heart rate(HR),blood pressure(BP)and heart rate-blood pressure product(RPP)in diagnosis and prognosis of postural tachycardia syndrome(POTS)in children and adolescents.Methods:From April 2012 to May 2019 this study included 91 subjects aged 5-16 years.53 children and adolescents aged 5-15 years with POTS diagnosed by head-up tilt test(HUTT)were enrolled in the Pediatric Syncope Clinic of The Second Xiangya Hospital of Central South University.There were 26 males and 27 females in POTS group.A total of 38 healthy children and adolescents aged 5-16 years old(19 males and 19 females)who underwent health examination in the Child Health Clinic of the hospital in the same period were matched as control group.Intervention(health education+oral rehydration salt+metoprolol)for POTS children and adolescents followed up for 139.13(86.00,192.26)days.According to the follow-up results,the children and adolescents were divided into two groups:responsive group(n=40)and nonresponsive group(n=13).Each group of children and adolescents collected at baseline(HUTT 0 min),HUTT 5 min,HUTT 10 min,with the corresponding time point heart rate(HR 0,HR 5,HR 10),systolic pressure(SBP 0,SBP 5,SBP 10)and heart rate and systolic pressure product(RPP 0,RPP 5,RPP 10).Use SPSS 25.0 software and EmpowerStats software for statistical analysis.Results:1.Demographic characteristics:A total of 91 cases were included in this study,including 53 cases in the POTS group(26 males and 27 females)and 38 cases in the control group(19 males and 19 females),with an average age of 11.28±2.03 years.The height in the POTS group was higher than that in the control group(151.46±13.46 cm vs 143.57±14.80 cm,t=-2.596,P=0.011).There was no statistical difference between the two groups in gender(male/female:26 cases/27 cases vs 19 cases/19 cases,x2=0.008,P=0.929),age(11.43±1.84 years vs 11.08±2.28 years,t=-0.811,P=0.419)and body weight(39.76±9.49 kg vs 37.55±11.92 kg,t=-0.944,P=0.349).In the POTS group,there was no statistical difference between the treatment have responsed group and the treatment have non-responsed group in gender(male/female:23 cases/17 cases vs 3 cases/10 cases,x2=3.377,P=0.066),age(12.38±1.94 years vs 11.65±1.98 years,t=-1.181,P=0.251),height(157.62±13.35 cm vs 151.90±12.85 cm,t=-1.354,P=0.191)and body weight(44.15±8.76 kg vs 40.83±10.02 kg,t=-1.148,P=0.263).2.Comparison of POTS group and control group:The POTS group was significantly higher than the control group in HR 5(115.45±14.50 beats/min vs 95.79±13.89 beats/min,t=6.494,P=0.000),HR 10(120.57±16.13 beats/min vs 96.05±12.43 beats/min,t=7.842,P=0.000),HRD 5(35.13±10.75 times/min vs 18.11±10.436 times/min,t=7.540,P=0.000),HRD 10(40.25±14.57 times/min vs 18.37±10.53 times/min,t=7.890,P=0.000),RPP 5(12814.55±2304.56 vs 10371.42±1910.20,t=5.747,P=0.000),RPP 10(13499.17±2360.40 vs 10523.18±1771.48,t=6.446,P=0.000).There was no statistically significant difference between the POTS group and the control group in HR 0(80.32±18.31 beats/min vs 77.68±10.37 beats/min,t=0.871,P=0.386),SBP0(110.85±10.50 mmHg vs 106.79±12.54 mmHg,t=1.677,P=0.097),SBP 5(111.66±10.95 mmHg vs 107.79±10.46 mmHg,t=1.694,P=0.094),SBP 10(111.85±12.77 mmHg vs 108.97±9.66 mmHg,t=1.168,P=0.246),RPP 0(8909.08±2239.86 vs 8335.47±1758.30,t=1.367,P=0.192).3.Comparison of the treatment have responsed group and the treatment have non-responsed group in POTS:The treatment have responsed group was significantly lower than the treatment have non-responsed group in HR 5(98.73±12.43 times/min vs 113.77±17.65 times/min,t=3.342,P=0.002),HR 10(96.90±13.96 times/min vs 119.08±13.52 times/min,t=4.731,P=0.000),HRD 5(23.00±9.99 times/min vs 37.00±13.67 times/min,t=3.900,P=0.000),HRD 10(21.18±11.66 times/min vs 41.58±14.29 times/min,t=5.045,P=0.000)and RPP 10(10819.58±2144.26 vs 13375.46±2807.01,t=3.252,P=0.002).There was no statistical difference between the treatment have responsed group and the treatment have non-responsed group in HR 0(75.73±9.93 beats/min vs.77.46±19.29 times/min,t=0.226,P=0.852),SBP 0(109.08±9.84 mmHg vs 111.85±11.58 mmHg,t=0.847,P=0.401),SBP 5(112.40±11.31 mmHg vs 112.46±13.29 mmHg,t=0.240,P=0.811),SBP 10(112.10±10.73 mmHg vs 111.62±13.72 mmHg,t=-0.157,P=0.876),RPP 0(8307.78±1250.60 vs 8724.38±2744.77,t=0.525,P=0.609),RPP 5(11125.45±1952.35 vs 12914.69±3192.12,t=1.932,P=0.075).4.Threshold effect:There is a non-linear relationship between SBP 10 and whether there is responsed after POTS treatment.When SBP 10 is less than 114 mmHg(1 mmHg=0.133 kPa),for every 1 mmHg increase in SBP 10,the probability of the treatment have responsed increases by 10%(P<0.05).5.Receiver operating characteristic curve(ROC)analysis:when HR 5 is 98.50 beats/min,the sensitivity for diagnosing POTS is 90.60%and the specificity is 60.53%;when HR 5 is 99.50 beats/min,to predict the sensitivity of the treatment have responsed in POTS is 88.30%and the specificity is 62.50%.When HR 10 is set at 111.50 times/min,the sensitivity to diagnose POTS was 73.58%and the specificity was 92.11%;when HR 10 was set at 115.50 times/min,to predict the sensitivity of the treatment have responsed in POTS is 66.70%and the specificity was 92.50%.When HRD 5 is 24.50 beats/min,the sensitivity to diagnose POTS is 86.79%and the specificity is 78.90%;when HRD 5 is 31.50 beats/min,to predict the sensitivity of the treatment have responsed in POTS is 75.00%and the specificity is 80.00%.When HRD 10 is 29.50 beats/min,the sensitivity for diagnosing POTS is 86.79%and the specificity is 89.50%;when HRD 10 is 36.50 beats/min,to predict the sensitivity of the treatment have responsed in POTS is 83.30%and the specificity is 92.50%.When RPP 5 is 11127.00,the sensitivity for diagnosing POTS is 79.25%and the specificity is 73.70%;when RPP 5 is 11548.50,to predict the sensitivity of the treatment have responsed in POTS is 69.20%and the specificity is 62.50%.When RPP 10 is 11549.50,the sensitivity of diagnosing POTS is 86.79%,and the specificity is 78.9%;when RPP 10 is 10988.00,to predict the sensitivity of the treatment have responsed in POTS is 91.70%,and the specificity is 57.50%.The sensitivity of the four combined indicators(HR 5,HR 10,HRD 5,HRD 10)to diagnose POTS is 96.20%,and the specificity is 89.50%;the four combined indicators(HR 5,HR 10,HRD 5,HRD 10)to predict the sensitivity of the treatment have responsed in POTS is 99.99%and the specificity is 75.00%.Conclusion:1.HR5,HR10,HRD5,HRD10,RPP5,RPP10 and four combined indicators(HR 5,HR 10,HRD 5,HRD 10)have predictive value for the diagnosis of POTS in children and adolescents.2.HR5,HR 10,HRD5,HRD 10,RPP10 and four combined indicators(HR 5,HR 10,HRD 5,HRD 10)have predictive value for the effects of POTS intervention in children and adolescents.3.The four combined indicators(HR 5,HR 10,HRD 5,HRD 10)are more effective in diagnosing POTS and predicting the effect after intervention than the single HR 5,HR 10,HRD 5,HRD 10,RPP 5,RPP 10 indicators in children and adolescents.17 Pictures,7 Tables,66 References...